Decreased incidence of lupus nephritis in northern Norway is linked to increased use of antihypertensive and anticoagulant therapy.

MedLine Citation:

PMID:
20647194
Owner:
NLM
Status:
In-Data-Review

Abstract/OtherAbstract:

METHODS: This is an observational study of two subsequent SLE inception cohorts based on 1982 American College of Rheumatology (acr) classification criteria (82acr; n = 87, enrolled 1978-95) and the updated version in 1997 (97acr: n = 62, enrolled 1996-2006). Annual incidence rates (AIR), point prevalence, clinical and histological features, and outcome of LN (defined as proteinuria with urinary casts and/or haematuria) were compared between both cohorts.RESULTS: Between 1978 and 2006, the AIR for LN decreased from 0.7 to 0.45/100 000, while LN prevalence rose from 7 to 14/100 000. The relative risk reduction in the 97acr for early- and late-onset LN (> 3 months after SLE diagnosis) was 39% and 42%, respectively. Patients developing LN in the 97acr cohort (97LN +; n = 11) had similar demographics, more often low avidity anti-dsDNA antibodies (Ab) and/or anti-cardiolipin Ab at SLE diagnosis, lower proteinuria and diastolic blood pressure, and similar histological findings to those in the 83acr cohort (82LN +; n = 28). Following LN diagnosis, more 97LN + patients received pulse corticosteroids (55% vs. 7%), anticoagulants (46% vs. 4%) and antihypertensive drugs (46% vs. 11%). Three 82LN + patients (11%) developed end-stage renal disease versus none in 97LN + during a 10-year follow-up.CONCLUSIONS: Early detection of low avidity anti-dsDNA and antiphospholipid antibodies, probably in combination with early use of protective cardiovascular measures from SLE diagnosis onwards may contribute to reduced incidence and improved renal survival in LN.